Abstract: TH-PO860
Post-Kidney Transplant Intracranial Aneurysm and Hemorrhagic Stroke in Polycystic Kidney Disease
Session Information
- Cystic Kidney Diseases: Clinical
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Genetic Diseases of the Kidneys
- 1001 Genetic Diseases of the Kidneys: Cystic
Authors
- Jandal, Ali D., University of Wisconsin, Madison, Wisconsin, United States
- Lyu, Beini, University of Wisconsin, Madison, Wisconsin, United States
- Astor, Brad C., University of Wisconsin, Madison, Wisconsin, United States
- Mandelbrot, Didier A., University of Wisconsin, Madison, Wisconsin, United States
- Djamali, Arjang, University of Wisconsin, Madison, Wisconsin, United States
- Bhutani, Gauri, University of Wisconsin, Madison, Wisconsin, United States
Background
Polycystic Kidney Disease (PKD) is associated with 6-9 times higher prevalence of intracranial aneurysm (ICA) and consequently, of hemorrhagic stroke than the general population. An appropriate screening strategy for ICAs in PKD post-kidney transplantation is not known.
Methods
The Wisconsin Allograft Recipient Database was queried to identify adult patients who received a primary kidney transplant at University of Wisconsin between 1/1/2000-12/31/2015. Cause of ESRD among kidney transplant recipients (KTRs) was categorized as PKD or non-PKD. History of ICA and hemorrhagic stroke at the time of transplant and incidence post-transplant were compared between PKD vs non-PKD using logistic regression and survival analysis.
Results
PKD recipients (N=520) were, in comparison to non-PKD (N=3494), older (52.8 vs 49.4 years), more often female (45% vs 38.8%) and white (93.5% vs 80.2%; p<0.01 for all). Pre-transplant dialysis was less common in PKD KTRs (56% vs 77%; p< 0.01). No significant difference was observed in pre-transplant hypertension (97.5% in PKD vs 96.2% in non-PKD KTRs; p=0.15).
A history of ICA and prior hemorrhagic stroke was significantly higher in PKD recipients compared to non-PKD KTRs (2.7% and 1.92% vs 0.3% and 0.63%;p<0.01) even after adjusting for demographics and pre-transplant hypertension. Over a median post-transplant follow up 5.6 years (2.4-9.1) in PKD and 5 years (2.1-8.1) in non-PKD recipients, the incidence of ICA was higher in PKD (1.6 vs 0.3 per 1000 person years in non-PKD; p=0.02). The incidence of hemorrhagic stroke was similar between PKD and non-PKD recipients (0.3 vs 0.8 per 1000 person years; p=0.36). No strokes occurred at time of transplant.
Conclusion
Our findings show that incidence of hemorrhagic stroke in PKD KTRs was low. Regular interval screening for new ICA may not be necessary in PKD patients following kidney transplantation. The factors contributing to change in frequency of hemorrhagic stroke in PKD and non-PKD group in the post-transplant setting need further investigation.
Table 1
| PKD (N=520) | Non-PKD (N=3494) | Odds/Hazard Ratio | P-value | |
| Pre-transplant ICA [N (%)] | 14.7 (2.7) | 12 (0.3) | 8.6 (3.8,19.4) | p<0.01 |
| Pre-transplant Hemorrhagic Stroke [N (%)] | 10 (1.92) | 22 (0.63) | 2.9 (1.4, 6.3) | p>0.01 |
| Post-transplant ICA [N (%)] | 5 (0.99) | 6 (0.17) | 4.6 (1.3,15.9) | p=0.02 |
| Post-transplant hemorrhagic Stroke [N (%)] | 1 (0.2) | 16 (0.46) | 0.39 (0.05,2.94) | p=0.36 |